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What is freedom? What is equality? And what is sovereignty? A foundational text of modern political philosophy, Rousseau's Social Contract has generated much debate and exerted extraordinary influence not only on political thought, but also modern political history, by way of the French Revolution and other political events, ideals, and practices. The Social Contract is regularly studied in undergraduate courses of philosophy, political thought, and modern intellectual history, as well as being the subject of graduate seminars in numerous disciplines. The book inspires an ongoing flow of scholarly articles and monographs. Few texts have offered more influential and important answers to research questions than Rousseau's Social Contract, and in this new Cambridge Companion, a multidisciplinary team of contributors provides new ways to navigate this masterpiece of political philosophy- and its animating questions.
In book III chapter 4 of the Social Contract, Rousseau takes up the political principle established by Montesquieu in the Spirit of the Laws by correlating the form of a polity’s government to the extent of its territory: it is impossible, in his view, to answer once and for all the question of the best regime, without considering the suitability of regime types for particular situations. Yet democracy could still have a crucial advantage in Rousseau’s system: this kind of government confers most power to the people. A republican state seems to call for a democratic regime. This is why Rousseau’s response may come as a surprise: far from being the best form of government, democracy is the worst – or at least it is not suitable for a people of men, not gods. This essay reassesses Rousseau’s case against democracy. Why does Rousseau declare that democracy causes, so to speak, “a government without government,” and threatens popular sovereignty itself? This paradoxical claim needs to be explained.
Reasoned and impassioned controversy have accompanied The Social Contract since its publication in 1762. Once the book entered conversations about the foundations and ends of modern politics, it never left them.
Immanuel Kant’s debt to Rousseau, for example, was deep and multidimensional. He drew many of his own ethical and political arguments from contemplating Rousseau’s philosophy, including the general will and other ideas that extended well beyond the portrait of Rousseau that famously adorned his otherwise sparsely decorated study.
Rousseau’s Social Contract begins with breathtakingly ambitious declarations about freedom and justice. Yet the project comes to an abrupt end, and the manuscript remains a fragment. Given that Rousseau sees daring arguments to their end elsewhere, why was this particular project – one so close to the core of his thought – abandoned? On the surface, the Social Contract appears beset by contradictions, but it pursues its conclusions toward an intricate and audacious coherence, giving an account of ancient political orders to overcome what Rousseau understands as misapprehensions associated with the Enlightenment. Yet it is not the Enlightenment, but Christianity that inaugurates the break with and confusions of ancient political distinctions. An attempt to confront this origin directly shatters Rousseau’s penultimately profound coherence. In remarkable congruence with patterns of figurative language developed in Descartes, Rousseau seeks to both ground and energize his account of political life by deploying diverse, often distinctly modern aspirations and metaphors in order to escape the Christian interruption of proper political ordering and concludes he cannot do so.
Cross-sectional studies have shown that the COVID-19 pandemic has had a significant impact on the mental health of healthcare staff. However, it is less well understood how working over the long term in successive COVID-19 waves affects staff well-being.
Aims
To identify subpopulations within the health and social care staff workforce with differentiated trajectories of mental health symptoms during phases of the COVID-19 pandemic.
Method
The COVID-19 Staff Wellbeing Survey assessed health and social care staff well-being within an area of the UK at four time points, separated by 3-month intervals, spanning November 2020 to August 2021.
Results
Growth mixture models were performed on the depression, anxiety and post-traumatic stress disorder longitudinal data. Two class solutions provided the best fit for all models. The vast majority of the workforce were best represented by the low-symptom class trajectory, where by symptoms were consistently below the clinical cut-off for moderate-to-severe symptoms. A sizable minority (13–16%) were categorised as being in the high-symptom class, a group who had symptom levels in the moderate-to-severe range throughout the peaks and troughs of the pandemic. In the depression, anxiety and post-traumatic stress disorder models, the high-symptom class perceived communication from their organisation to be less effective than the low-symptom class.
Conclusions
This research identified a group of health service staff who reported persistently high mental health symptoms during the pandemic. This group of staff may well have particular needs in terms of the provision of well-being support services.
Anorexia nervosa (AN) is a psychiatric disorder with complex etiology, with a significant portion of disease risk imparted by genetics. Traditional genome-wide association studies (GWAS) produce principal evidence for the association of genetic variants with disease. Transcriptomic imputation (TI) allows for the translation of those variants into regulatory mechanisms, which can then be used to assess the functional outcome of genetically regulated gene expression (GReX) in a broader setting through the use of phenome-wide association studies (pheWASs) in large and diverse clinical biobank populations with electronic health record phenotypes.
Methods
Here, we applied TI using S-PrediXcan to translate the most recent PGC-ED AN GWAS findings into AN-GReX. For significant genes, we imputed AN-GReX in the Mount Sinai BioMe™ Biobank and performed pheWASs on over 2000 outcomes to test the clinical consequences of aberrant expression of these genes. We performed a secondary analysis to assess the impact of body mass index (BMI) and sex on AN-GReX clinical associations.
Results
Our S-PrediXcan analysis identified 53 genes associated with AN, including what is, to our knowledge, the first-genetic association of AN with the major histocompatibility complex. AN-GReX was associated with autoimmune, metabolic, and gastrointestinal diagnoses in our biobank cohort, as well as measures of cholesterol, medications, substance use, and pain. Additionally, our analyses showed moderation of AN-GReX associations with measures of cholesterol and substance use by BMI, and moderation of AN-GReX associations with celiac disease by sex.
Conclusions
Our BMI-stratified results provide potential avenues of functional mechanism for AN-genes to investigate further.
Throughout the coronavirus disease 2019 (COVID-19) pandemic, health and social care workers have faced unprecedented professional demands, all of which are likely to have placed considerable strain on their psychological well-being.
Aims
To measure the national prevalence of mental health symptoms within healthcare staff, and identify individual and organisational predictors of well-being.
Method
The COVID-19 Staff Wellbeing Survey is a longitudinal online survey of psychological well-being among health and social care staff in Northern Ireland. The survey included four time points separated by 3-month intervals; time 1 (November 2020; n = 3834) and time 2 (February 2021; n = 2898) results are presented here. At time 2, 84% of respondents had received at least one dose of a COVID-19 vaccine. The survey included four validated psychological well-being questionnaires (depression, anxiety, post-traumatic stress and insomnia), as well as demographic and organisational measures.
Results
At time 1 and 2, a high proportion of staff reported moderate-to-severe symptoms of depression (30–36%), anxiety (26–27%), post-traumatic stress (30–32%) and insomnia (27–28%); overall, significance tests and effect size data suggested psychological well-being was generally stable between November 2020 and February 2021 for health and social care staff. Multiple linear regression models indicated that perceptions of less effective communication within their organisation predicted greater levels of anxiety, depression, post-traumatic stress and insomnia.
Conclusions
This study highlights the need to offer psychological support to all health and social care staff, and to communicate with staff regularly, frequently and clearly regarding COVID-19 to help protect staff psychological well-being.
The 3-d food diary method (3-d FD) or the 2-d duplicate plate (2-d DP) method have been used to measure dietary fluoride (F) intake by many studies. This study aimed to compare daily dietary F intake (DDFI) estimated by the 3-d FD and 2-d DP methods at group and individual levels. Dietary data for sixty-one healthy children aged 4–6 years were collected using 3-d FD and 2-d DP methods with a 1-week gap between each collection. Food diary data were analysed for F using the Weighed Intake Analysis Software Package, whereas duplicate diets were analysed by an acid diffusion method using an F ion-selective electrode. Paired t test and linear regression were used to compare dietary data at the group and individual levels, respectively. At the group level, mean DDFI was 0·025 (sd 0·016) and 0·028 (sd 0·013) mg/kg body weight (bw) per d estimated by 3-d FD and 2-d DP, respectively. No statistically significant difference (P=0·10) was observed in estimated DDFI by each method at the group level. At an individual level, the agreement in estimating F intake (mg/kg bw per d) using the 3-d FD method compared with the 2-d DP method was within ±0·011 (95 % CI 0·009, 0·013) mg/kg bw per d. At the group level, DDFI data obtained by either the 2-d DP method or the 3-d FD method can be replaced. At an individual level, the typical error and the narrow margin between optimal and excessive F intake suggested that the DDFI data obtained by one method cannot replace the dietary data estimated from the other method.
The prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization among Emergency Medical Services (EMS) personnel is not well studied. Methicillin-resistant Staphylococcus aureus colonization can be a health hazard for both EMS personnel and patients. The aim of this study was to quantify the prevalence of MRSA colonization among EMS personnel. This study will help the scientific community understand the extent of this condition so that further protocols and policies can be developed to support the health and wellbeing of EMS personnel.
Hypothesis/ Problem
The hypothesis of this study was that the prevalence of MRSA colonization among EMS personnel is significantly higher than among the general population.
Methods
This was a cross-sectional study. A total of 110 subjects were selected from two major US Mid-Atlantic fire departments. Methicillin-resistant Staphylococcus aureus colonization was detected by nasal swabbing. Nasal swabs were inoculated onto a special agar medium (C-MRSAgar) with polymerase chain reaction testing performed. One-sided binomial distribution at the StudySize 2.0 Web calculator was used. Using the Web calculator, p (H0 proportion) = 1.5%; a difference (H1-H0) ‘Δ’ = 4.53% can be detected at α = 5% and power = 80% with N = 110.
Results
Samples were collected from 110 volunteers. Seven samples were positive for MRSA, resulting in a prevalence of 7/110 or 6.4% (95% CI, 1.8%-11%; P < .0003) compared with a 1.5% prevalence of MRSA colonization among the general population.
Conclusion
There is evidence that EMS personnel have a higher prevalence of MRSA colonization than the general population. This can be a risk to patients and can be recognized as an occupational hazard.
Al AmiryA, BissellRA, MaguireBJ, AlvesDW. Methicillin-Resistant Staphylococcus Aureus Nasal Colonization Prevalence among Emergency Medical Services Personnel. Prehosp Disaster Med. 2013;28(4):1-5.
Jean-Jacques Rousseau's Discourse on Political Economy has been largely neglected, and the little attention it has received has been widely disparate. This chapter argues that the primary and unifying aim of the third Discourse is to define the best form of government for safeguarding individual or negative liberty. It also argues that the thread that connects the seemingly disparate elements of the text is a commitment to defining the institutions and policies that might best guarantee the preservation of property rights with a minimum degree of government infringement. Most crucially, even in defending the individual right to property possession, Rousseau is consistently critical of the pursuit of property, and especially the pursuit of superfluities or luxuries. He insists throughout the third Discourse that the primary task of popular and legitimate government is to make virtue reign.